P.05.22 INFLAMMATORY BOWEL DISEASES AND PERICARDITIS

P.05.22 INFLAMMATORY BOWEL DISEASES AND PERICARDITIS

Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220 S118 P.05.20 SPLANCHNIC HAEMODYNAMIC...

57KB Sizes 1 Downloads 19 Views

Abstracts of the 18th National Congress of Digestive Diseases / Digestive and Liver Disease 44S (2012) S55–S220

S118 P.05.20

SPLANCHNIC HAEMODYNAMICS AND INTESTINAL VASCULARITY IN ILEAL CROHN’S DISEASE. AN IN VIVO EVALUATION USING DOPPLER ULTRASOUND, CONTRAST-ENHANCED ULTRASOUND AND BIOCHEMICAL PARAMETERS E. Bolzacchini ∗ ,1 , J. Maier 2 , A. Dell’Era 2 , F. Furfaro 1 , A. Cassinotti 1 , S. Ardizzone 1 , R. De Franchis 1 , G. Maconi 1 1 Gastrointestinal 2 Department

Unit - Luigi Sacco University Hospital, Milan, Italy; of Clinical Sciences - L.Sacco University Hospital, Milan, Italy

Background and aim: Crohn’s disease (CD) is characterized by inflammation, angiogenesis and microvascular remodeling of affected bowel. These features have been associated with damage to mesenteric vascular blood supply and with impaired splanchnic haemodynamics (SH). We evaluated the SH and microvascular changes in response to a standard meal in patients with ileal CD. Material and methods: 16 pts with ileal CD (mean age 39) and 10 healthy controls were included. Doppler ultrasound (US) of portal vein and superior mesenteric artery was used to assess quantitative and semiquantitative indexes (flow volume, resistance and pulsatility indexes). Vascular perfusion of terminal ileum was assessed by color-Doppler US (resistance index of arteriolar bed of bowel wall) and real-time contrast-enhanced US (CEUS), after the injection of 2.4 ml of sulfur hexafluoride-filled microbubbles (SonoVue, Bracco, Milan, Italy) and vascularity was quantified (Q-ontrast, Bracco, Milan) using different kinetic parameters of perfusion. Inflammation, angiogenesis and endothelial function were evaluated by measuring VEGF, TNF-a and NO. All measurements were performed before and 30 min after a meal (Resource Energy - Nestlè, 300 kcal). Statistical analysis was performed using Wilcoxon and Spearman’s rank correlation tests. Results: Basal and postprandial SH and CEUS parameters did not differ between CD patients and controls, whilst resistance index of arteriolar bed, detectable only in CD patients, showed a significant reduction after meal. NO and TNF-a significantly reduced after meal only in CD patients. A significant correlation was found between CEUS parameters of vascular perfusion, and VEGF before the meal (r= 0.63-0.71; p<0.05).Furthermore, we found a significant correlation between splanchnic blood flow and CEUS parameters of vascular perfusion during fasting (r= 0.66-0.79; p<0.05), but not in the postprandial period. Conclusions: In ileal CD patients, splanchnic blood flow is correlated with vascular perfusion of the intestinal wall, which is related to VEGF. This is evident during fasting, not in the post-prandial period, where other vasoactive factors are probably involved.

P.05.21 CLINICAL COURSE OF PERIANAL FISTULAS IN CROHN’S DISEASE: A RETROSPECTIVE STUDY L. Alessandroni 1 , L.G. Papparella ∗ ,1 , M.C. Addarii 1 , I. Guadagni 1 , C. Papi 2 , A. Khon 1 1 Azienda

Ospedaliera San Camillo Forlanini, Roma, Italy; 2 Azienda Ospedalira San Filippo Neri, Roma, Italy Background and aim: Perianal fistulas are frequent complications of Crohn’s disease (CD) that can result in significant morbidity, reduced QoL and need for costly medical therapy. Despite the importance of this condition, little is known about long term outcome and risk for defunctioning stoma or proctectomy over time. The aim of the present study is to retrospectively determine the negative outcomes defined as definitive damage (anorectal stenosis/faecal incontinence) and defunctioning stoma or proctectomy for these patients. Material and methods: We selected all CD patients with perianal fistulas that were diagnosed and classify with examination under anesthesia at the Surgical Department of the San Camillo Forlanini Hospital from 1980 to 2010. Recto-vaginal and recto-urethral fistulas were excluded. The follow-up was calculated from diagnosis to appearance of a negative outcome or to the end of follow-up. Patients were divided in 3 cohorts according to the time of diagnosis (A: 1980-1989, B: 1990-1999, C: 2000-2010).

Results: 114 patients (41.2% females, median age 49 yrs [range 18-91]) with perianal fistulas were analyzed; 19 (17%) had ileal disease, 35 (30%) had colonic and 60 (53%) ileocolonic involvement. Complex fistulas were diagnosed in 97 (85%) patients (86 transphincteric, 5 suprasphincteric, 6 extrasphincteric), 17 (15%) had simple fistulas (11 superficial, 6 intersphincteric), 75 (66%) had an associated abscess and 77 (67%) rectal involvement. The median follow up was 96 months (range 0-240); within this period 84% underwent 1 surgical procedure, 64%, 47%, 23% and 9% underwent respectively 2, 3, 4 and 5 different surgical procedures. The cumulative probability of course free from negative outcome was 0.69 at 20 years, not influenced by the type of fistula, but significantly higher when the rectum was involved (0.55, p< 0.001). The cumulative probability of proctectomy or stoma was not significantly different for the three cohorts (A, B, C) of patients. Conclusions: Our results suggest that, in the long term, the risk of definitive damage, proctectomy or stoma is high (31%), apparently not influenced by the type of fistula, but by the rectal localization of the disease. Despite the introduction of novel biological treatments over the last decade, the cumulative probability of negative outcomes in the long term did not change significantly.

P.05.22 INFLAMMATORY BOWEL DISEASES AND PERICARDITIS G. Inserra ∗ ,1 , G. La Ferrera 1 , L. Samperi 1 , L. Zanoli 1 , M.R. Cannavò 1 , I. Monte 2 1 Medicina

Interna, Azienda Policlinico, Catania, Italy; 2 Cardiologia, Azienda Policlinico, Catania, Italy Background and aim: Extra-intestinal manifestations in IBD sometimes involve serous layers such as peritoneum, pleura and pericardium. In literature only few cases of pericarditis and pleuro-pericarditis among IBD pts have been reported. However their prevalence and etiopathogenesis are not known. We evaluated, with echocardiography, the presence of cardiac involvement in a group of IBD pts, and described their clinical characteristics. Material and methods: From January to October 2010, performing a study on prevalence of early atherosclerosis among IBD pts, we evaluated 19 pts (10M, 9F; 8 CD, 11 UC; 21-54 years), asymptomatic and with negative anamnesis for cardiopathy. All underwent ECG and Echocardiogram, relieving M-Mode, Doppler and Color-Doppler parameters (diameter and parietal thickness of left ventricular, ejection fraction, atrial volume left, MAPSE, TAPSE and transmitral flow velocity, pericardium evaluation). Echocardiogram was assessed positive for pericarditis in presence of a detachment of pericardial layers. Results: All pts had normal ECG and indexes of cardiac function between normal range. 6/19 pts showed thickening of pericardial layer (5 with detachment = 2 mm, 1 with detachment of 3 mm). The clinical characteristics of pts are resumed in Table 1. No one was submitted to invasive exams or therapeutic treatments for pericarditis because asymptomatic and no evident cardiac alteration appeared at 3 and at 6 months of follow-up.

Table 1 Males Females Mean age (years) Crohn RCU Azathioprine, 6-MP Anti-TNFα 5-ASA Mean time of disease duration (years) Clinical remission

Pericarditis (n=6)

No Pericarditis (n=13)

3 3 37.3 2 4 0 2 3 6.8 4

6 7 31.1 6 7 4 2 7 6.1 7

Conclusions: To date pericarditis in IBD is supposed to be a rare and casual event. It is not evident wether it belongs to extra-intestinal manifestations or is a complication linked to infective factors. In our group of pts pericarditis was diagnosed in 32%. Our findings on a little sample suggest that pericarditis could be relatively common in IBD and that has a very benign course. More studies on a larger population will be necessary to know the exact prevalence and the most important risk factors associated.